With Rare Comity, Senate Panel Advances Bills to Lower Health Costs

WASHINGTON — The Senate health committee approved a package of bills on Wednesday aimed at lowering the cost of medical care, from ending surprise medical bills to curbing prescription drug price surges, with a rare bipartisan vote that could vault it toward final passage.

Still, even some Democrats who supported the legislation couched it as cold comfort as the Trump administration prepares to argue before a federal appeals court next month that the entire Affordable Care Act should be struck down as unconstitutional.

The cost-cutting legislation is a priority of Senator Lamar Alexander of Tennessee, the health committee chairman who will retire next year and is seeking a victory after his plan last year with Senator Patty Murray of Washington to stabilize the Affordable Care Act insurance markets failed.

The new package includes a plan to eliminate surprise medical bills, which have become a hot political cause this year, targeted by President Trump and lawmakers from both parties. It also addresses the rising cost of prescription drugs, with a set of provisions that limit the games pharmaceutical companies can play to protect monopolies on the drugs they sell.

Other proposals seek to chip away at the opacity around medical prices, a goal that Mr. Trump also seized on with a new executive order this week intended to require insurers, doctors and hospitals to inform patients how much their care will cost before they receive it. The package also includes a measure from Senator Mitch McConnell of Kentucky, the majority leader, to raise the smoking age in every state to 21 from 18.

Mr. Alexander, who worked on the package with Ms. Murray, the committee’s ranking Democrat, emphasized that it included proposals from 36 Democrats and 29 Republicans.

“This legislation will help to lower the cost of health care, which has become a tax on family budgets and on businesses, on federal and state governments,” Mr. Alexander said after the package passed, 20 to 3. Senators Elizabeth Warren of Massachusetts and Bernie Sanders of Vermont, who are seeking the Democratic nomination for president, and Rand Paul of Kentucky, a Republican, voted no.

The decision to add the majority leader’s bill to the mix should help the package reach the Senate floor this summer. Mr. McConnell, a longtime ally of the tobacco industry, has said concerns about the high rate of youth vaping motivated him to support raising the minimum age for buying e-cigarettes as well as tobacco.

His proposal followed a major tobacco and e-cigarette industry campaign to raise the minimum age, known as “Tobacco 21,” an apparent effort to distance companies from accusations that they have deliberately marketed their products to youths to hook a new generation.

There has been broad consensus in Washington to eliminate so-called surprise medical billing — when patients receive medical care, then get bills from providers they did not choose. But doctors, hospitals and insurance companies have disagreed about exactly what should happen when patients are treated by doctors and other medical professionals who do not have agreements with insurance companies.

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President Trump signed an executive order on Monday intended to require insurers, doctors and hospitals to inform patients how much their care will cost before they receive it.CreditGabriella Demczuk for The New York Times

The Alexander bill would require insurance companies to pay hospitals, doctors, laboratories and air ambulances the median price they pay to providers they have signed contracts with. (It would not prevent surprise bills for regular ambulance rides, even though research has suggested that more than half occur outside patients’ insurance networks.)

Chip Kahn, the president of the Federation of American Hospitals, which represents investor-owned hospitals, said in a statement after the vote that the Alexander bill “misses the mark,” adding, “This bill solves the immediate problem for patients, but the unintended consequences of rate setting will lead to more narrow networks and a precedent of government interference in free-market negotiations.”

Mr. Paul, an ardent libertarian, said the surprise-billing piece amounted to price fixing. “I don’t think we’re becoming Venezuela soon, but this is part of what they do down there,” he said before the vote.

But Mr. Alexander’s approach now has momentum, and a key House committee’s leadership has brought forward a similar proposal.

Wednesday’s vote came two weeks before the Trump administration and a group of 18 Republican-led states are scheduled to argue before the Fifth Circuit Court of Appeals in New Orleans that a Texas judge’s decision last year to throw out the entire Affordable Care Act should be upheld. A group of 21 Democratic-led states, headed by California, appealed that ruling, and Democrats are hoping the case will prove to be a powerful incentive for voters to reject Mr. Trump and other Republican candidates in the 2020 election.

“You know what the biggest surprise bill the American people will ever see?” Brad Woodhouse, a veteran Democratic strategist and the executive director of Protect Our Care, a health care advocacy group, said in a conference call with reporters on Tuesday. “It will be the elimination of the Affordable Care Act by the lawsuit in Texas.”

Senator Christopher S. Murphy, a Connecticut Democrat on the health committee, said on the call that when Republicans controlled both the House and the Senate, “they didn’t use any of that time trying to control costs.”

“They spent it trying to take away care from 30 million Americans, period,” he went on. “I understand Republicans are going to desperately try to get well on the issue of health care after they spent two years trying to steal it from tens of millions of Americans. I just don’t think it’s going to work.”

Democrats have continued to focus primarily on access to health insurance as they gear up for the 2020 campaign, with proposals for a single-payer health system or a “public option” that would let more Americans qualify for Medicare or other government coverage.

Mr. Trump and other Republicans, having failed to repeal the health law in Congress, have pivoted to proposals aimed at reducing the medical costs Americans pay. Mr. Alexander said he hoped his legislation would get a floor vote next month, perhaps combined with another bipartisan set of bills, focused on lowering drug prices, that the Senate Finance Committee is working on.

Margot Sanger-Katz and Sheila Kaplan contributed reporting.

A version of this article appears in print on , Section A, Page 16 of the New York edition with the headline: Health Care Bills Advance In a Rare Show of Comity. Order Reprints | Today’s Paper | Subscribe